FELINE LOWER URINARY TRACT DISEASE (FLUTD)

"Feline Lower Urinary Tract Disease" or FLUTD is the term describing the following group of clinical signs:

• bloody urine
• straining to urinate
• frequent urination
• urinating in unusual places (outside of the litter box)
• urinary blockage (almost exclusively a male cat problem)
• frequent licking of the genital area
• pain while urinating (meowing or howling)

Some cats with FLUTD develop crystals in their urine. In the male cat, these crystals can block his urethra preventing him from urinating even though the bladder still fills. Sometimes, a plug can form and also block the urethra. FLUTD is a serious disease and if left untreated, it can result in death.

This problem was previously called "Feline Urologic Syndrome," "FUS," or simply "cystitis" (meaning literally "inflamed bladder"). Because the syndrome can have many possible causes, it was renamed to discourage the perception that the clinical signs seen represent one disease with one cause. In fact, the key to treatment is the determination of a cause if this is possible.

Affected cats feel the irritation in their urinary tract and have an urge to urinate. Quite often, bacteria accompany the crystals increasing the level of discomfort. Cats suffering from FLUTD try to urinate more often than normal, often crying out whilst doing so. Owners may notice small drops of blood tinged urine in the litter tray.

Urinary crystals or "plugs" made of a mixture of inflammatory cells, thick mucous-like material (usually from inflammation of the bladder wall and/or crystals) can get stuck in a male cat urethra causing a blockage to the flow of urine. The male urethra is surrounded by small muscles, which sometimes spasm/cramp when there is a blockage or irritation in the urethra, thus compounding the initial blockage.



A "blocked" male cat is in a life threatening situation. The kidneys keep making urine despite the fact that the cat can not pass it. The bladder gets bigger and bigger, and the kidneys start to get a huge amount of back pressure of urine applied to them. There is a dramatic rise in the amount of potassium in the bloodstream as a result of this, which causes an irregular heartbeat. Death can occur within 24-36 hours of a complete blockage.

Since all these symptoms are variable and can be quite subtle, the important point to remember is to observe your cats urinary habits on a daily basis and have your pet checked if there is any change to these habits. If any of the above symptoms are occurring, bring your pet immediately to be evaluated by a veterinarian.



Frequent straining and urination



Several factors can contribute to this disease including bacterial or viral infections, trauma, crystals in the urine, bladder stones, tumors of the urinary tract, and congenital abnormalities. In many cases, the cause is never discovered. Factors that may contribute to development of FLUTD include:

• Not drinking enough water
• A diet high in magnesium or other minerals
• Too much acidity or alkalinity of the urine
• Stress

Central to treating a cat with FLUTD is determining which of many possible causes is present. It turns out that different diseases are common in different age groups of cats with this syndrome.

The average age of a cat with FLUTD is 4 years. Of all cats with FLUTD:

• 50% will not have a cause which can be determined despite extensive testing
• 20% will have bladder stones
• 20% will have a urethral blockage
• 1-5% will have a true infection
• 1-5% will have a urinary tract cancer
• 1-5% will have had trauma to the urinary tract (i.e. have been hit by a car etc.)
• 1-5% will have a combination of a bladder stone and an infection

If one looks only at cats over age 10 years of age, the likely possibilities are completely different. In this older group:

• 50% will have true urinary tract infections
• 10% will have bladder stones
• 17% will have a combination of infection and bladder stone
• 7% will have urethral blockage
• 3% will have urinary tract cancer
• 5% will not have a cause that can be determined despite extensive testing.

Further:

• 66% will be in some stage of kidney failure
• 5% will have urinary incontinence

In younger cats, there is a 50% chance that testing will be fruitless. Given this, testing beyond an examination and urinalysis may not be performed unless the syndrome is recurrent. In older cats, it is more important to look for a diagnosis. A blood panel, urinalysis and urine culture will detect the 50% of cats who have urinary tract infections and the 66% that are in kidney failure. Radiographs will pick up the presence of bladder stones.



A thorough history and physical exam go a long way towards making this diagnosis. Urine samples, blood samples, and even x-rays are used in some cases to verify the diagnosis and eliminate other diseases that can cause similar symptoms. Urine samples can be hard to obtain because these cats urinate as soon as urine fills the bladder due to the inflammation caused by the crystals. Urine is usually collected using a procedure called 'cystocentesis.' In this procedure, a fine needle is inserted into the bladder through the abdomen to get a sterile specimen.

Your veterinarian may perform a 'urinalysis' that will indicate if there are crystals, bacteria, blood, or white blood cells in the urine; the urine pH and also how concentrated the urine is (called 'specific gravity'). The veterinarian may also take radiographs (X-rays) to look for stones, tumors, or congenital abnormalities.

This is a picture of a cat's abdomen. The large, round and whitish area towards the right is the urinary bladder (B) that is distended because this cat cannot urinate. Compare it to the normal sized bladder below.

The normal sized bladder (B) in this cat is much smaller. In addition you can see the Large Intestines (L.I.), the kidney (K) and the small intestines (S.I.).

Urine samples can be useful. This one shows that there is blood in the urine and no bacteria are noted. This is typical of FLUTD.

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